Department of Surgery, Division of Emergency Medicine, Duke University, Durham, North Carolina, United States of America.
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
PLoS One. 2019 Jan 25;14(1):e0211287. doi: 10.1371/journal.pone.0211287. eCollection 2019.
Globally, hypertension affects one billion people and disproportionately burdens low-and middle-income countries. Despite the high disease burden in sub-Saharan Africa, optimal care models for diagnosing and treating hypertension have not been established. Emergency departments (EDs) are frequently the first biomedical healthcare contact for many people in the region. ED encounters may offer a unique opportunity for identifying high risk patients and linking them to care.
Between July 2017 and March 2018, we conducted a prospective cohort study among patients presenting to a tertiary care ED in northern Tanzania. We recruited adult patients with a triage blood pressure ≥ 140/90 mmHg in order to screen for hypertension. We explored knowledge, attitudes and practices for hypertension using a questionnaire, and assessed factors associated with successful follow-up. Hypertension was defined as a single blood pressure measurement ≥ 160/100 mmHg or a three-time average of ≥ 140/90 mmHg. Uncontrolled hypertension was defined as a three-time average measurement of ≥ 160/100 mmHg. Successful follow-up was defined as seeing an outpatient provider within one month of the ED visit.
We enrolled 598 adults (mean age 59.6 years), of whom 539 (90.1%) completed the study. The majority (78.6%) of participants were aware of having hypertension. Many (223; 37.2%) had uncontrolled hypertension. Overall, only 236 (43.8%) of participants successfully followed-up within one month. Successful follow-up was associated with a greater understanding that hypertension requires lifelong treatment (RR 1.11; 95% CI 1.03,1.21) and inversely associated with greater anxiety about the future (RR 0.80; 95% CI 0.64,0.99).
In a northern Tanzanian tertiary care ED, the burden of hypertension is high, with few patients receiving optimal outpatient care follow-up. Multi-disciplinary strategies are needed to improve linkage to care for high-risk patients from ED settings.
全球范围内，高血压影响了 10 亿人口，而中低收入国家受到的负担不成比例。尽管撒哈拉以南非洲地区的疾病负担很高，但尚未建立用于诊断和治疗高血压的最佳护理模式。急诊科（ED）通常是该地区许多人的第一个生物医学保健接触点。ED 就诊可能为识别高危患者并将其与治疗联系起来提供独特的机会。
2017 年 7 月至 2018 年 3 月期间，我们在坦桑尼亚北部的一家三级保健 ED 进行了一项前瞻性队列研究。我们招募了分诊血压≥140/90mmHg 的成年患者，以筛查高血压。我们使用问卷探讨了高血压的知识、态度和做法，并评估了与成功随访相关的因素。高血压定义为单次血压测量≥160/100mmHg 或三次平均血压≥140/90mmHg。未控制的高血压定义为三次平均血压测量≥160/100mmHg。成功随访定义为 ED 就诊后一个月内看门诊医生。
我们招募了 598 名成年人（平均年龄 59.6 岁），其中 539 名（90.1%）完成了研究。大多数参与者（78.6%）知道自己患有高血压。许多人（223 人；37.2%）患有未控制的高血压。总体而言，只有 236 名（43.8%）参与者在一个月内成功随访。成功随访与更了解高血压需要终身治疗相关（RR 1.11；95%CI 1.03，1.21），与对未来的焦虑程度降低相关（RR 0.80；95%CI 0.64，0.99）。
在坦桑尼亚北部的一家三级保健 ED，高血压的负担很高，很少有患者接受最佳的门诊护理随访。需要采取多学科策略来改善 ED 高危患者的护理衔接。
